An even larger Republican majority will be in control of the Missouri legislative session that begins tomorrow. Most of Missouri’s legislative Republicans oppose Medicaid expansion, but some still want Medicaid coverage to be a top issue.

Senator Ryan Silvey (photo courtesy, Missouri Senate Communications)

Senator Ryan Silvey (photo courtesy, Missouri Senate Communications)

“Clearly Obamacare is something that’s not popular in the state of Missouri and a lot of members see anything around healthcare as being Obamacare,” Senator Ryan Silvey (R-Kansas City), told Missourinet. “The problem that we need to deal with as a legislature is how are we going to define what Obamacare is and how are we going to address it?”

Silvey thinks the gap in coverage that many Missourians fall into means reform is needed. Missourians whose income falls between 19 and 138 percent of the federal poverty level are not covered for Medicaid or by federal subsidies on private insurance.

“Clearly nobody thinks that adding a bunch of people to the current Medicaid system, as was imagined in the Affordable Care Act, is the way to go. In fact, myself, have voted against that multiple times,” Silvey said. “A restructure of how Medicaid is delivered in this state needs to happen before we do anything about putting more people into the system.”

Silvey says legislation he offered last year included “sweeping” reforms, but it was blocked by a filibuster by members of his own caucus. He says he’ll offer legislation again this year.

“Certainly addressing the coverage gap is going to be one issue. Changing the delivery system of Medicaid is clearly very important,” he said. “My plan is to offer several options and then if my colleagues decide that this is a debate that we should have there’ll be several options to start from.”

Silvey says the challenge will be getting his fellow Republicans to allow that debate.

“I would like to have a policy debate but they refuse to engage in a policy debate. They refuse to offer alternative plans. It’s simply just a filibuster to kill, not a filibuster to solve.”

He believes there are enough supportive votes in the legislature to pass a Medicaid proposal, and he says the fact that opponents are filibustering it is proof of that.

“The fact that it’s being filibustered tells you that there is support in the general assembly enough to pass a reform package,” he said.

Some conservatives believe the outcome of the November election, which saw Republicans grow their majorities in the state legislature, was a signal that Missourians support their policies including the opposition to Medicaid expansion. Silvey thinks, though, there are other signals to be read.

“[Governor] John Kasich in Ohio got reelected in a landslide and he found a state solution to the problem in Ohio, Rick Scott got reelected in Florida, [Rick] Snyder in Michigan, [Scott] Walker in Wisconsin. All over this country governors who have focused on a state-centered solution to push back on Washington and reform the Medicaid system all got reelected,” said Silvey. “I think there’s still a strong narrative to be made that we need to be focusing on a Missouri-specific solution and we need to push back in Washington against the Affordable Care Act with our own reforms and our own solution to Medicaid.”